Why We Disclose: Part Two of Four

We are continuing our four part series on self-disclosure within the treatment setting. This week’s edition is a discussion on the identified key principles that should be used when thinking about disclosures, from Dr. Wendy Oliver-Pyatt, MD, FAED, CEDS.

Many forms of disclosures come out whether we like it or not. When you work in a residential, versus outpatient office for instance, certain critical aspects of your life are more easily revealed. For example, your patients observe how you interact with other staff and patients. This reveals something about who you are. On a more superficial level the patients may be more likely to see what car you drive or a new engagement ring (or maybe the therapist is no longer wearing her ring.) It is not really whether one self discloses, it is more the degree to which one self discloses. How to manage those very natural questions our patients have about us without shaming them for their natural curiosity, all while being aware of what impact we may be having in our chosen or unchosen disclosure.

When you employ many staff with varying histories, one must develop systems around what to teach employees about self-disclosure. This comes up more frequently when you hire staff that literally “live” with the patient, as in a 24-hour care or transitional living setting. These staff may eat, sleep, go into the community, and use the same bathroom as your patients each day. The relationship expands beyond the walls of a therapy room in ways that can’t be contained in such a controlled manner. How do you guide employees or other therapists who work in a milieu setting?

I have identified what I think are four key principals that I believe should be used when thinking about disclosure in general (not just an eating disorder history):

1) Am I still struggling with this personal issue, break-up, or conflict? Would I be talking about this with the patient because I need to talk about it with someone? If this is the case, the self-disclosure absolutely must not be shared. In this case, the disclosure becomes the patient’s burden and is not their responsibility. Talk about your problems with family, friends, and therapists and not our clients. Never share something that is still emotionally charged for you, which you are still working through.

2) When you are considering sharing something with a patient, ask yourself, “Could this information be in any way harmful to the patient or confuse my role with the patient?” When sharing our histories, patients may feel uncomfortable and responsible for us, or worried about us. This can bring up deeper feelings the patient may have about being responsible for other people, or guilty feelings about their own needs. This can be especially significant with eating disorder patients where some of the patients were given excessive responsibility at a premature age and/or there are issues around differentiation. Most importantly, the patient may have many other feelings that you may not be aware of.

3) Does sharing this information actually benefit the client somehow?  Questions to ask yourself about whether it is potentially helpful include: Does this information demonstrate something helpful, such as the ability to laugh at oneself (humor,) to move through or overcome hardship, inspire a client to follow one’s dreams, help the client develop his or her own vision of recovery, or take an important leap forward?  I have found this is where disclosure of my history in eating disorder work can profoundly impact a patient.

4) If the client is to know more about the issue, how likely is it they could process in therapy the thoughts and emotions that arise as a result of knowing (both positive AND negative?) If there is some evidence in the relationship that the patient is able to openly address feelings in the relationship with the therapist, both positive and negative, then the patient is demonstrating an ability to talk about the downside the disclosure may bring up.

Check back next Thursday for the continuation of this series.